The Zhang 2013 paper does not say what it is represented as saying in this article. There was not a 20% discontinuation rate. There was a 17% rate of statin-related events but only a 10% discontinuation rate...for all causes, including "no longer necessary", "too expensive" and other non-ADR reasons. Only 12% of discontinuations explicitly for adverse reaction (the authors do note that reporting may have underestimated the ADR rate by a large factor, but they did not have positive evidence of this). Of those patients who discontinued statins, more than 90% were rechallenged and most went on to tolerate statin therapy long-term.
Even more dubiously, the author states that these figures are "massively at odds with the major statin trials that report significant side effects of myopathy or muscle pain in only one in 10 000." Since no reference was provided, I looked into it myself. The Astra-Zeneca product information for Crestor (rosuvastatin) reports that myalgia is common (i.e. 10% or more) and myopathy and rhabdomyolysis are rare, but occur at rates of 0.2-0.4%, much higher than the ~0.01% reported in this article. I haven't gone through every statin study, but I think it's clear that the article has massively misrepresented the evidence on this point.
The saturated fat hypothesis needs challenging, the effectiveness of statins as a large-population intervention needs challenging, and pharmaceutical company data needs challenging, but not like this.
Competing interests:
No competing interests
24 October 2013
Chris Lawson
GP Lecturer
Sunshine Coast Clinical School, University of Queensland
Nambour General Hospital, Level 4 Block 3, Nambour
The Zhang 2013 paper does not say what it is represented as saying in this article. There was not a 20% discontinuation rate. There was a 17% rate of statin-related events but only a 10% discontinuation rate...for all causes, including "no longer necessary", "too expensive" and other non-ADR reasons. Only 12% of discontinuations explicitly for adverse reaction (the authors do note that reporting may have underestimated the ADR rate by a large factor, but they did not have positive evidence of this). Of those patients who discontinued statins, more than 90% were rechallenged and most went on to tolerate statin therapy long-term.
Even more dubiously, the author states that these figures are "massively at odds with the major statin trials that report significant side effects of myopathy or muscle pain in only one in 10 000." Since no reference was provided, I looked into it myself. The Astra-Zeneca product information for Crestor (rosuvastatin) reports that myalgia is common (i.e. 10% or more) and myopathy and rhabdomyolysis are rare, but occur at rates of 0.2-0.4%, much higher than the ~0.01% reported in this article. I haven't gone through every statin study, but I think it's clear that the article has massively misrepresented the evidence on this point.
The saturated fat hypothesis needs challenging, the effectiveness of statins as a large-population intervention needs challenging, and pharmaceutical company data needs challenging, but not like this.
Competing interests: No competing interests